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Harm reduction for smokers with little to no quit interest: can tobacco policies encourage switching to e-cigarettes?
  1. John Buckell1,2,
  2. Lisa M Fucito3,
  3. Suchitra Krishnan-Sarin3,
  4. Stephanie O'Malley3,
  5. Jody L Sindelar4
  1. 1 Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, UK
  2. 2 Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
  3. 3 Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
  4. 4 Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA
  1. Correspondence to Dr John Buckell, Health Economics Research Centre, University of Oxford Nuffield Department of Population Health, Oxford OX3 7LF, UK; john.buckell{at}


Objective A pressing tobacco policy concern is how to help smokers who have little interest in quitting cigarettes, a group that often suffers severe health consequences. By switching from cigarettes to e-cigarettes, they could obtain nicotine, potentially with less harm. We examined if policy-relevant attributes of cigarettes/e-cigarettes might encourage these smokers to switch to e-cigarettes.

Methods An online survey and discrete choice experiment on a nationally-representative sample of adult smokers in the US who reported low interest in quitting (n=2000). We modelled preference heterogeneity using a latent class, latent variable model. We simulated policies that could encourage switching to e-cigarettes.

Results Participants formed two latent classes: (1) those with very strong preferences for their own cigarettes; and (2) those whose choices were more responsive to policies. The latter group’s choices were only somewhat responsive to menthol cigarette bans and taxes; the former group’s choices were unresponsive.

Conclusions The policies studied seem unlikely to encourage harm reduction for individuals with little interest in quitting smoking.

  • electronic nicotine delivery devices
  • cessation
  • economics

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  • Contributors Guarantor: JB; Conception or design of the work: JB, JLS, LMF, SO, SK-S. Acquisition of the data: JB, JLS. Analysis of the data: JB, JLS. Interpretation of data for the work: JB, JLS, LMF, SO, SK-S. Drafting the work: JB, JLS, LMF, SO, SK-S. Final approval of the version to be published: JB, JLS, LMF, SO, SK-S.

  • Funding Research reported in this publication was supported by grant numbers U54DA036151 from the NIDA and FDA Center for Tobacco Products (CTP) and K12 DA000167 from NIDA.

  • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the Food and Drug Administration. It was also supported by the NIHR Oxford Biomedical Research Centre.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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